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HIV testing in patients with end stage renal disease
BMJ (Clinical Research Ed.)
|February 17, 1990
Summary
Nephrologists show varied policies for human immunodeficiency virus (HIV) testing in patients with end-stage renal failure awaiting renal replacement therapy. A consensus is needed for consistent HIV screening practices in this vulnerable population.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- End-stage renal failure (ESRF) necessitates renal replacement therapy (RRT), including dialysis and transplantation.
- Human immunodeficiency virus (HIV) infection poses risks in ESRF patients, influencing RRT decisions.
- Current practices for HIV testing among ESRF patients considered for RRT lack standardization.
Purpose of the Study:
- To investigate the current policies of British and Irish nephrologists regarding HIV testing in ESRF patients.
- To identify variations in testing approaches for dialysis versus transplantation candidates.
- To understand nephrologists' views on HIV positivity as an exclusion criterion for RRT modalities.
Main Methods:
- A survey was distributed to 128 British and Irish nephrologists concerning their HIV testing policies for ESRF patients.
- 101 (79%) nephrologists responded, providing data on testing strategies, criteria, and attitudes towards positive results.
- Data analysis focused on differences in testing approaches for dialysis and transplant candidates, and implications of HIV status.
Main Results:
- Significant variation exists in HIV testing policies: one-third tested only at-risk dialysis candidates, while nearly one-fifth deemed testing unnecessary.
- For transplantation, 68% of respondents performed routine HIV testing, 22% tested only at-risk individuals, and 10% did not test.
- Most respondents (63/86) would exclude HIV-positive patients from transplantation, but fewer would exclude them from hemodialysis (24/88) or peritoneal dialysis (7/87).
Conclusions:
- Nephrologists' approaches to HIV testing in ESRF patients are inconsistent, particularly concerning risk assessment and RRT modality decisions.
- There is a need to establish a clear consensus on HIV testing protocols to ensure equitable and safe patient management.
- Standardized guidelines are crucial for addressing ethical considerations and clinical decision-making regarding HIV status in ESRF patients.